初步探讨超声检查在胰肾联合移植(SPK)术后监测中的应用价值。

回顾性分析青岛大学附属医院2019年8月至11月完成的5例行SPK供、受者超声检查资料。5例供者术前行常规二维超声检查，评估肾脏和胰腺大小、内部回声。供器官获取后依次行肾移植和胰腺移植。术后1周内每天行超声检查1次，1周后每3天1次，1个月后每2个月1次，或根据病情需求行超声检查。采用重复测量资料方差分析比较SPK移植前、移植后第1、7天和第1个月移植胰腺和肾脏大小以及移植后第1、3、7天及第1个月移植胰腺及肾脏内动脉收缩期最大流速(PSV)、阻力指数(RI)，进一步两两比较采用LSD法。P<0.05为差异有统计学意义。

常规二维超声显示术后1周内移植胰腺形态饱满，实质回声偏低、均质，胰管无扩张；移植肾形态饱满，皮质回声均匀，皮髓质分界清晰，集合系统无分离。5例SPK受者术后第1天移植胰腺胰头、胰体和胰尾以及肾脏长径、前后径和左右径均大于移植前，差异均有统计学意义(P均<0.05)；术后第1个月移植胰腺胰头、胰体和胰尾以及肾脏长径均小于术后第1天，差异均有统计学意义(P均<0.05)。移植术后1周内彩色多普勒血流显像检查示胰腺内动、静脉血流显示较好，胰腺内动脉PSV为16.6～37.2 cm/s，RI为0.52～0.70。5例移植胰腺中4例门-腔静脉血流显示良好，频谱呈双相波或三相波等体静脉频谱特征。1例术后门-腔静脉吻合口显示欠清，超声造影检查示动脉期移植胰腺肠系膜上动脉、脾动脉及实质内小动脉分支顺次清晰显影，静脉期门-腔静脉、脾静脉显影，实质内未见异常灌注区。5例移植肾脏三级血流显示清晰，肾动脉PSV为24.2～123.0 cm/s，RI为0.55～0.81。5例受者术后第1、3、7天和第1个月移植胰腺内胰头动脉和胰体尾动脉以及移植肾内肾叶间动脉、肾段动脉和肾门动脉PSV、RI差异均无统计学差异(F＝0.182、0.953、1.321、1.867、2.121和1.588、0.544、3.902、2.752、0.956，P均>0.05)。1例维吾尔族男性受者术后第22天怀疑发生急性排斥反应，予甲泼尼龙冲击治疗后恢复正常。截至2020年2月，5例受者术后均恢复良好，移植肾脏与胰腺功能良好，肾功能及血糖水平均恢复正常。

超声可以作为SPK术后动态监测的首选影像学检查方法，了解移植物大小、体积、内部回声和血流动力学等情况，对早期发现术后并发症有重要价值。

To preliminarily analyze the application value of ultrasonography on postoperative monitoring of simultaneous pancreas-kidney transplantation (SPK).

The ultrasonographic data of 5 cases undergoing SPK in the Affiliated Hospital of Qingdao University from August 2019 to November 2019 were retrospectively analyzed. Five donors underwent conventional two-dimensional ultrasound examination before transplantation to assess the size and internal echo of the kidney and pancreas. Kidney transplantation and pancreas transplantation were performed in turn. Ultrasound examination was performed once a day within 1 week after transplantation, once every 3 days after 1 week, and once every 2 months after 1 month, or according to the condition. The peak systolic velocity (PSV) and resistance index (RI) of the transplanted pancreas and kidney before and after transplantation and at the 1st, 3rd, 7th and 1st month after transplantation were compared using the repeated measure of ANOVA, Least-Significance Difference was used for pairwise comparison. A P<0.05 was considered statistically significant.

Conventional two-dimensional ultrasound showed that within 1 week after the operation, the transplanted pancreas was plump, with low parenchymal echo, homogeneous and no dilatation of the pancreatic duct; and the transplanted kidney is plump in shape, with uniform cortical echo, clear boundary of cortex and medulla, and no separation of collection system. The anteroposterior diameter of transplant pancreas head, body, tail, and the long diameter, anteroposterior diameter and left and right diameter of transplant kidney were all longer than before the transplantation (all P<0.05). The anteroposterior diameter of transplant pancreas head, body, tail and the length of transplant kidney 1 month after transplantation were all smaller than that of the first day (all P<0.05). Color doppler flow imaging (CDFI) showed that the vascular display of all branches in pancreas was good in 5 cases within 1 week after transplantation, the PSV of the internal pancreatic artery is 16.6-37.2 cm/s, and the RI is 0.52-0.70, the portal-vena cava in 4 cases showed well and the frequency spectrum was characterized by two-way or three-way wave. The postoperative portal-vena cava anastomosis showed poor clarity in 1 case, contrast-enhanced ultrasonography was performed: the blood flow of superior mesenteric artery, splenic artery, arteriloes of transplant pancreas showed well in the arterial-phase, and portal-vena cava and splenic vein were shown in the venous-phase. No perfusion disorders was found in pancreatic parenchyma. Five cases of transplanted kidney showed clear three-level blood flow, the PSV of the renal artery was 24.2-123.0 cm/s, RI was 0.55-0.81. There were no statistically significant differences in PSV and RI between the head and tail arteries of transplant pancreas, interlobar, segmental and hilar arteries of transplant kidney of the 5 recipients at the 1st, 3rd, 7th and 1st month after transplantation (F=2.823 and 0.881, all P>0.05). One Uyghur male recipient was suspected of acute rejection on the 22nd day after transplantation, and returned to normal after being treated with methylprednisolone. Up to February 2020, all 5 recipients have recovered well after the transplantation, the transplanted kidney and pancreas function well, and the renal function and blood glucose levels have returned to normal.

Ultrasonography can serve as the preferred imaging examination for dynamic monitoring after SPK. It can help to evaluate the size, volume internal echo and the blood flow of the grafts. This is of great value for early detection of postoperative complications.